Provider Demographics
NPI:1669731188
Name:EADS, TYLER J (MD)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:J
Last Name:EADS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 FAIRFAX PARK
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2807
Mailing Address - Country:US
Mailing Address - Phone:205-345-2211
Mailing Address - Fax:205-345-2220
Practice Address - Street 1:1031 FAIRFAX PARK
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2807
Practice Address - Country:US
Practice Address - Phone:205-345-2211
Practice Address - Fax:205-345-2220
Is Sole Proprietor?:No
Enumeration Date:2012-05-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ALMD.33563208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program